100 FLASHCARDS
Mortality indicators
Flashcard:#1
Indicator
Use
Crude death rate
Risk of death in a population
Age specific death rate
Identify high risk age groups for mortality PYQ
Proportional mortality rate
•
•
Identify most common cause of death
Mortality indicator for burden of disease PYQ
Case fatality rate
•
•
Severity of disease
Indicate virulence PYQ
Age standardised death rate
Compare mortality pattern between two
populations with different age structure PYQ
Standardised mortality ratio
Compare mortality between occupation vs General
population PYQ
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #2
Incidence Vs prevalence
Incidence
Prevalence
New cases among population at risk
Existing cases at one point of time
Study: Cohort study PYQ
Study: Cross sectional study PYQ
PYQ Measures rate of occurrence of disease
Express proportion of diseased
Requires follow up
Does not require such follow up
Denominator: Population at risk
Denominator: Total population
PYQ To study cause to effect relationship
Cannot be used
To study etiological hypothesis
Cannot be used
Indicates risk of developing disease PYQ
Indicates burden of disease PYQ
Does not depend on duration of illness
Depends on duration of illness (P = I x D) PYQ
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #3
New intervention: Impact on incidence and prevalence
Intervention
Incidence
Prevalence = I x D
A new effective treatment for No change
cancer / NCD
Ex: Surgical intervention
Decrease PYQ
A new treatment for cancer No change
prolonging survival but no cure
Ex: Chemotherapy
Increase (Prolonged duration)
A new effective treatment for Decrease
communicable disease
(Transmission reduced)
Ex: TB
Decrease (since I reduced)
A new prophylactic intervention Decrease PYQ
Ex: Vaccine, chemoprophylaxis (Prevent new cases)
Decrease (since I reduced)
PYQ
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #4
Index: HDI vs PQLI Vs MDPI
Human development index
Dimensions
Indicators PYQ
Knowledge
Mean yrs of schooling
Expected yrs of schooling
Income
Longevity
PQLI
Multidimensional poverty index
Dimensions
Indicators
IMR PYQ
Health
Child mortality PYQ
Nutrition
Per capita GNI PYQ
Literacy rate
Education
Years of schooling
School attendance
LE at birth PYQ
LE at age 1
Living
Standards
Cooking fuel, water
Toilet, Electricity
Floor, assets
To express
quality of life
To compare poverty levels
To compare standard of living PYQ
Recent update: 0.633 (Rank 132)
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #5
Summary measures of Public health
✓
✓
To express burden of disease
Considers both mortality and morbidity of
diseasePYQ
❑
DALYs = YLL + YLDPYQ
▪
▪
YLL – Yrs of life lost
YLD – Yrs lived with disability
QALYs (Quality adjusted life years)
✓
✓
✓
To express effectiveness of interventionPYQ
Considers both quantity and quality of life
Quality of life : Expressed by Utility value
HALE (Health adjusted life expectancy)
✓ Number of yrs a newborn can live in full healthPYQ
✓ Lesser than life expectancy
DALYs (Disability adjusted life years)
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #6
Health indicators
Morbidity Indicators
Notification rate, OPD attendance , Admission rate, Duration of
hospital stay PYQ, Spells of sickness/Sickness absenteeism PYQ ,
Incidence/prevalence PYQ
Health Care Delivery
Doctor population ratio, Population bed ratio PYQ, Population per PHC
Health Care Utilization
% of infants immunized, Bed occupancy rate, Average length of
stay, Bed turnover ratio PYQ
Health Policy Indicators
% GDP spent on health PYQ
Disability Indicators
Event type
Person type
- No. of days of no activity
- Bed disability days PYQ
–Limitation of mobility
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #7
Source vs Reservoir
Reservoir: In which an infectious agent lives and multiplies
Source: from which an infectious agent passes to the host
Hook worm
Typhoid
Tetanus
Reservoir
Source
Man
Man
Soil
Soil with larvae
Water, food
Soil
Dr. Rajeev Shetty
MD PSM (MAMC,NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Flashcards: #8
Modes of transmission
Direct transmission
Indirect transmission
1. Direct contact : Contact, Sexual Intercourse
1. Vehicle borne : Food , water
2. Droplet infection :
The droplet spread is limited to a distance of
30-60 cm between source and host
2. Air borne :
-Droplet nuclei : 1-10 microns dried
residues of droplets
-Dust
3. Contact with soil
3. Vector borne
4. Inoculation into skin/mucosa: Needle, Dog bite 4. Fomite borne
5. Transplacental (Vertical)
5. Unclean hands
Dr. Rajeev Shetty
MD PSM (MAMC,NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Flashcards: #9
Successful parasitism : 4 stages
Portal Of Entry
Ex: Droplets through inhalation
Site Of Selection
Ex: Multiply in throat
Portal Of Exit
To spread to others
Dead-end infection : If there is no portal of exit
Ex: JE, tetanus, yellow fever, bubonic plague, hydatid disease,
trichinosis, rabies
Favourable Environment
After leaving the human body, the organism must survive in the
external environment for sufficient period till a new host is found.
Dr. Rajeev Shetty
MD PSM (MAMC,NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Flashcards: #10
Time in epidemiology
Incubation period:
Time between exposure and first sign/symptoms.
Median incubation
period:
Time required for 50% of cases to occur after exposure
Generation time :
Time taken from receipt of infection to develop maximum
infectivity.
Serial Interval :
✓ Gap in onset between primary case and secondary case
✓ Indirect estimate of incubation period
Period of
communicability :
Latent period:
Time during which an infectious agent may spread
✓ Period from disease initiation to disease detection
✓ Used for NCDs
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #11
Incubation period (IP)
IP : Depends upon –
Uses of IP :
1. Portal of entry
1. Tracing the source of infection
2. Infectious dose
2. To decide to vaccinate contacts or not
3. Generation time or doubling
time of agent
3. To classify epidemics
4. Susceptibility of host
4. To estimate prognosis: Short IP-Worst prognosis
5. To decide Period of quarantine : Max IP
6. To decide Period of surveillance after an outbreak :
2 x IP
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #12
Measures of spread :
Attack Rate ( AR)
Reflects extent of epidemic
AR=
Secondary Attack
Rate (SAR):
No. of new cases X 100
Population at risk
To assess communicability within closed contacts
PYQ
SAR= No. of secondary cases X 100
‘susceptible’ contacts
Basic reproduction
number
Number of cases generated by one case in
completely susceptible populationPYQ
Indicate spread of disease in completely
susceptible population
Effective
reproduction number
Number of cases generated by one case in
Mixed population (Immune + Susceptible) PYQ
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #13
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Periodic fluctuation : Types
Reasons :
Ex:
Seasonal trend :
Cyclical trend -
Wrt season
Is occurrence of a disease in
cycles (weeks, months or years)
• Environmental condition PYQe.g.
temperature, rainfall
• vector variations
Build up of susceptibles is
required (Herd immunity
variations) ex: Measles PYQ
✓ PYQMeasles, varicella - early
spring
✓ URTI - winter
✓ Acute gastroenteritis – summer
✓ Measles (every 2-3 years)
✓ Rubella (every 6-9 years)
✓ Influenza pandemics (every
10 years)
Antigenic variations ex:
InfluenzaPYQ
Flashcards: #14
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Definitions
Epidemic
•
Cases in excess of normal expectancy
Endemic
•
Constant presence of a disease in a defined geographical area
Types of Endemic :
Pandemic:
-
Hyper –endemicPYQ : Constant presence of a disease at high level and
affects all age groups equally
-
Holo-endemicPYQ : Active transmission among children compared to
adults Ex: Malaria
•
Country-to country spread
Ex: Swine flu
COVID-19
Sporadic :
Haphazard and irregular distribution of casesPYQ
Ex: JE in uttar Pradesh
Flashcards: #15
Epidemic ; Types
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Single exposure (Point source Continuous/Multiple exposure
epidemic)
Propagated Epidemics
Sharp rise and sharp fall
Sharp rise’ in no. of cases
No secondary wavesPYQ
Secondary waves presentPYQ
Gradual rise and gradual fall
‘ over a long time with some
secondary waves
All cases develop within 1 IP
Cases develop after IP
Ex : Food poisoningPYQ
Bhopal gas tragedy
Minamata disease
Ex :
-Contaminated well PYQ
Results from person –toperson transmission PYQ
Cases can develop after IP
-Contaminated food
stocks/VaccinePYQ
Speed of spread depends
upon immunity PYQ
- Prostitute for gonorrhea
Ex : Polio PYQ , Hep A,COVID
-Legionnaires Disease outbreak in
PhiladelphiaPYQ
Flashcards: #16
Surveillance : TYPES
Passive Surveillance : •
Data reported to the health systems
• Patient visits health centres and cases are notified
Active Surveillance : Search for cases
Ex:
• Fortnightly visits for malaria (By health worker male ) PYQ
•
AFP surveillancePYQ
•
Kala azar fortnight
•
Leprosy case detection campaign
• TB active case finding
Sentinel surveillance Data collection from sentinel units like selected medical colleges, labs
Uses :
• To estimate trends in larger populationPYQ
•
To identify missed cases PYQ
•
Supplementing notified casesPYQ
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #17
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Vaccine : Types
Live Vaccines
Subunit vaccinesPYQ
Killed vaccines
Toxoid
Protein
Recombinant DNA
Poysaccharide
Influenza
Hep BPYQ
Meningococcal
ACWYPYQ
BCG
IPV
Diptheria
Measles /MR /
MMR
Rabies vaccine
Tetanus
Rotavac
Cholera – Dukoral
Pneumococcal
JE (SA 14-14-2) PYQ
PertussisPYQ
Hib
Yellow fever (17D)
Killed plague vaccine
PYQ
Typhoral- Ty21a
Killed influenza
Live plague vaccine
JE – Nakayama .
Beijing strain PYQ
Live influenza
KFD vaccine
Varicella vaccinePYQ
OPV
Typhoid Vi
Flashcards: #18
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Vaccine : Strains
Vaccine
Strain(s)
BCG
Danish-1331 strain
Measles
Edmonston Zagreb strain (MC) PYQ
Schwartz strain
Moraten strain
Mumps
Jeryll Lynn strainPYQ
RIT 4385
Rubini strain (Not to be used ) PYQ
Rubella
RA 27/3PYQ
Yellow fever
17 D strainPYQ
Varicella
OKA strainPYQ
Japanese encephalitis
Nakayama strain
Beijing strain
SA 14-14-2 (Used in India) PYQ
Malaria
RTS/S
Flashcards: #19
National immunisation schedule
IPV 3rd dose
Dr. Rajeev Shetty
MD PSM (MAMC,NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Flashcards: #20
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Adverse effect of vaccines
Vaccine
Adverse effect
Onset
BCG
•
•
•
Suppurative lymphadenitis
BCG osteitis
Disseminated BCG infection
2-6 months
1-12 months
1-12 monthsPYQ
Measles/MR/MMR
•
•
•
•
Febrile seizure
ThrombocytopeniaPYQ
Encephalopathy
Toxic shock syndromePYQ
24-48 hrs
OPV
•
VAPP (Vaccine associated paralytic polio) PYQ
4-30 days
Pertussis (Whole cell)
•
•
•
•
Persistent (>3 hours) screaming
Seizures
Hypotonic, hypo responsive episode(HHE) PYQ
Encephalopathy
0-48 hours
-
Tetanus toxoid/ Td
•
Brachial neuritis
2-28 days
Rotavac
•
IntussusceptionPYQ
1-7 days
Influenza (Killed)
•
Gullain bairre syndromePYQ
-
Yellow fever (17D)
•
Vaccine associated viscerotropic disease
-
Flashcards: #21
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
AEFI classification :
Product related
reactionPYQ
Quality defect
related reaction
Limb swelling after DPT
Failure to inactivate IPV leads to
paralysis
Immunization errorPYQ Infection after contaminated vials –
Toxic shock syndrome
Anxiety reaction
Vaso-vagal syncope
Coincidental
Fever by malaria after vaccination
session but not related to vaccines.
Flashcards: #22
Upper limits for 1st dose
Till 1 year
Till 5 year
BCG , PentavalentPYQ Rotavac , IPV , PCV
OPV , Measles / MR
Till 7 year
Till 15 year
DPTPYQ
JE
Dr. Rajeev Shetty
MD PSM (MAMC,NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Flashcards: #23
Sensitivity of vaccines :
Heat sensitive
Freeze sensitive
Light sensitive
Reconstituted BCG > OPV
Hep B >
BCG , Measles , MR/MMR
Dr. Rajeev Shetty
MD PSM (MAMC,NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Flashcards: #24
VVM: Vaccine vial monitor
✓
✓
✓
✓
VVM indicates cumulative heat exposurePYQ
Cannot indicate freeze exposure
Cannot directly indicate potency/efficacyPYQ
PYQ 4 STAGES :
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #25
SHAKE TEST:
✓
It is done on suspect vial to check for
freeze damagePYQ
✓
To check rate of sedimentation
between control and test vials
Sedimentation
in test vial
Slow
Fast / same pace
Use
Discard
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #26
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
OPEN VIAL POLICY
Open vial policy :
• Reuse of partially used multi dose vials in subsequent session
up to four weeks (28 days) PYQ
• To reduce vaccine wastage
Conditions that must
be fulfilled for the
use of open vial
policy:
✓ Date and time mentionedPYQ
✓ The expiry date has not passed
✓ Stored under appropriate cold chain conditions
✓ Vaccine vial septum has not been submerged in water or
contaminated
✓ Aseptic techniques used to withdraw vaccine doses
✓ VVM : has not reached the discard pointPYQ
Not applicable to :
BCG , Measles/MRPYQ , JE , Rotavac , Covishield/covaxin
Applicable to :
DPT, Td, OPV , IPV , PCV , Hep B , PentavalentPYQ
Covid vaccines - types
Flashcards: #27
Covishield
Covaxin
COVID VACCINES:
Type
Viral vector
Killed
(Chadox1)
Sputnik V
Moderna
Pfizer
ZycoV-D
Viral vector
(rad 26 for 1st
dose and rad 5
for 2nd dose)
mRNA
mRNA
Plasmid
DNA
Schedule
Gap between
doses
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
2 doses
12-16 wks
4-6 wks
3 wks
Dose , Route
3 doses
4 wks
3 wks
0.5 ml , intramascular
4 wks
0.1 ml , id
(Needle
free –
pharmajet
technique)
Storage
temp
Efficacy
2-8 C
60-80%
81%
2-8 C (freeze
dried form)
2-8 C (for 1
month) and
-20 C (For 6
months )
-70 C (For 6
months)
2-8 C
91%
94%
95%
66%
Flashcards: #28
COVID VACCINES: FAQs
✓ If covid positive : Give vaccine 3 months after recovery
✓ If covid patient received plasma / Abs : Give vaccine 3 months after discharge
✓ If infected after 1st dose of vaccine : Give 2nd dose 3 months after recovery
✓ Lactation : give vaccine
✓ Pregnancy : give vaccine
✓ Gap between Covid vaccine and Tetanus toxoid : 2 weeks
✓ Gap between Covid vaccine and rabies prophylaxis : No gap
Dr. Rajeev Shetty
MD PSM (MAMC,NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Flashcards: #29
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Levels of prevention
Levels
Purpose
Modes of intervention
Primordial level
Prevent onset of risk factors
Mass education
Primary level
Risk factor modification
Health promotion
Specific protectionPYQ
Secondary level
Prevent complicationsPYQ
Screening/Early detectionPYQ
Diagnosis
Treatment
Tertiary level
Improve quality of life
Disability limitation
RehabilitationPYQ
Revise ur notes under this chapter for further details – examples,mnemonics etc
Flashcards: #30
Case study vs Case series
Case study / case report
Case series
✓ To study one atypical case
✓ To study set of cases with
atypical manifestation
✓ Ex: A patient working in dye
industry presenting with
numbness of feet
✓ No comparision group (Controls
used in case control study )
✓ Ex: A group of slum dwellers
presenting with dementia and
altered
sensorium. etc
Revise ur notes under this chapter for further details
– examples,mnemonics
Revise ur notes
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #31
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Cross Sectional Study
✓ Study is done ‘at one point of time’
✓ So k/a snapshot study
Uses
To estimate ‘Point Prevalence’
To estimate burden of disease
Limitations :
No incidence
No temporal association
Not used for etiological purpose
Revise ur notes under this chapter for further details
Flashcards: #32
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Case control study : steps
Selection of cases
Selection of control :
with disease under study
Controls must be free from disease under study
Sources of controls:
Matching
Retrospective
of exposure:
Analysis
General population : ideal way to select healthy controls
Hospital controls: From OPDs
Relatives: Sibling controls are unsuitable in genetic studies
It eliminates the effect of known confounding factors.
assessment To check pattern of exposure in both cases and controls .
To estimate Exposure rates and Odds ratio
Revise ur notes under this chapter for further details
Flashcards: #33
Difference :
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
CASE CONTROL STUDY
COHORT STUDY
Proceeds from effect to cause
Proceeds from cause to effect
Comparing exposure between cases vs controls
Comparing incidence between exposed vs non exposed
Retrospective
Can be prospective or retrospective
Relatively quick to conduct
Time consuming (Prospective study)
Relatively inexpensive
Costlier
Can study multiple exposures for a disease
Can study multiple outcomes for an exposure
Suitable for rare disease
Not suitable
Recall bias seen
Attrition bias (Loss to follow up) seen
Odds ratio is estimated
Can calculate risk ratio or relative risk
Revise ur notes under this chapter for further details
Flashcards: #34
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Measures of risk
Relative Risk (Risk ratio )
Formula
Incidence in exposed
Incidence in non-exposed
Use
Direct measure of the strength of
the association between suspected
cause & effect.
RR = 1 : No association
RR > 1 : Positive association.
RR < 1: Negative association.
Attributable Risk
Aka Risk difference.
Population Attributable Risk
(PAR)
I exp– I non-exp x 100
I exp
To express amount of disease
which can be prevented among
exposed if exposure is eliminated
I total population – I non-exp x 100 To estimate the amount of disease
I total population
could be reduced in the population
if the exposure was eliminated
Most important for policy makers
Revise ur notes under this chapter for further details
Flashcards: #35
Random sampling
Randomisation
• Aka Random selection
• Aka Random
allocation/assignment
• Select study subjects from
reference population
• Allocate groups to receive new
intervention or placebo
• Eliminate selection bias : During
selection of study subjects
• Eliminate selection bias : During
treatment allocation
• Equal chance of selection
• Equal chance of receiving either
intervention/placebo
• Study sample will represent
reference population
• All prognostic factors are
equally distributed between 2
groups : Increase comparability
among study subjects
• Results can be generalised to
reference population : k/a
External validity
• Results are applicable within
study subjects : K/a internal
validity
• Can increase External validity
• Can increase Internal validity
Revise ur notes under this chapter for further details
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #36
To manage drop outs during analysis in RCT
Intention to treat analysis:
Drop outs are included in the analysis and
are analysed in the same group as they
were randomized
So, randomization is kept intact
Per protocol analysis
Drop outs are not included in the analysis
Analysis is done based on what they have
actually recieved in the study
So, randomization is not kept intact
Implies that the results of a RCT are
unaffected by attrition (loss to follow up)
or change over of study subjects from one
group to another
Revise ur notes under this chapter for further details
Flashcards: #37
Cross over RCT
Advantages
Disadvantages
✓ It helps removing ethical
concerns : because both
groups will receive new
intervention either in phase 1
or phase 2
✓ For curative treatments or
rapidly changing conditions,
cross-over trials may be
infeasible or unethical. So not
used in these conditions
✓ The same patient who was
recieving new intervention in
phase 1 will receive placebo in
phase 2. So patient serves as
their own control.
✓ Preferred mainly for chronic
conditions
Revise ur notes under this chapter for further details
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #38
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Method Used to control Confounding
During study
During analysis
Randomization
✓ Under RCT
✓ Can eliminate known and unknown confounders
Restriction
Limiting study to people who have particular
characteristics
Matching
✓ Useful in case control studies
✓ Eliminate known confounders
Stratification
Grouping common characteristics and analyse
Statistical
modeling
✓ If many confounding variables exist simultaneously
✓ Neutralising effect- Using regression models
Extra edge Topic
Flashcards: #39
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Meta analysis : steps
FOREST PLOT : Report results after meta-analysis
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Flashcards: #40
VDPVs and VAPP
VDPVs
VAPP
3 types –
c- Circulating : most common
i-Immunodeficiency
a-ambiguous
REASON
Strains of poliovirus in OPV may change &
revert to a form that can cause paralysis &
circulation (cVDPV)
Strain of polio virus that has
genetically changed in intestine
from original attenuated vaccine
strains in OPV (Abdomen)
Problem
Irregular vaccine coverage
Live vaccine for congenitally
immunodeficient child
Mutation
Type 2 component
SABIN 3 component
Outbreaks
Yes
No
PREVENTION
SWITCH (t-OPV replaced by b-OPV )
SHIFT (OPV replaced by IPV )
Flashcards: #44
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
Mass blood survey: Filariasis
Thick film
MC method used for epidemiological assessment of
Filariasis
Using Thick film of capillary blood (collected between
830pm upto 12 midnight) PYQ
Membrane Filter
Concentration Method
DEC Provocation testPYQ
Most sensitive method for detecting low density
microfilaraemia
Mf can be induced to appear in blood during daytime
Examined one hour after using DEC
Malariometric indices
Annual parasitic incidence (API):
Flashcards: #45
API =
Dr. Rajeev Shetty
Faculty DAMS: 2013-2022
New cases during one year x 1000
Population under surveillance
Elimination strategies are planned based on APIPYQ
Annual blood examination rate
(ABER):
ABER = Number of slides examined
x 100
Population under surveillance
Index of operational efficiencyPYQ
Slide positivity rate (SPR)
Spleen rate:
Infant parasite rate:
Should be > 10% PYQ
SPR =
No.of blood smears +ve for parasite x 100
No.of blood smears examined
% of 2–10 years age showing enlargement of spleen
To assess endemicity of malaria in a communityPYQ
Percentage of infants showing parasite in blood films
Is ‘most sensitive index of recent malaria transmission’ PYQ
Flashcard 59 : RASHTRIYA KISHOR SWASTHYA KARYAKRAM
Objectives
Promote Nutrition
Promote Adolescent reproductive and sexual health
Promote mental health
Prevent injuries and violence
Prevent substance abuse
Prevent NCDs
Strategies
Adolescent friendly health clinics (AFHCs)
Peer educator approach : SAATHIYA for counselling
WIFS : Weekly IFA supplementation scheme for adolescents
(Blue IFA tab : 60 mg elemental iron and 500 microgram folic acid )
Menstrual hygiene scheme : Distribute sanitary pads for rural
adolescents under the brand name “FREE DAYS”
7 Cs
Coverage , Content , Communities , Clinics , Communication ,
Counselling , Convergence
Flashcard 60 : JSY incentives
States : LPS/HPS
(Based on % of hospital
deliveries )
Eligibility for cash
assistance
LPS: UP,Uttarakhand,MP,Chattisgarh,Bihar,Jharkhand,
Rajasthan,Odisha,Jammu-Kashmir,Assam
HPS : Other states
LPS : All pregnants
HPS: BPL /SC-ST pregnants
( Note : Its irrespective of age and parity )
CASH incentives
Institutional delivery :
RURAL AREA
URBAN AREA
Mother ASHA
Mother ASHA
LPS
1400
600
1000
400
HPS
700
600
600
400
Home delivery : 5OO rs for BPL pregnants
Flashcard 61 :Schemes to reduce MMR
NISCHAY
Pregnancy testing kits
JSY (JANANI SURAKSHA YOJANA )
Cash incentives for deliveries
JSSK ( JANANI SHISHU SURAKSHA
KARYAKRAM )
Free service for pregnant and sick infants
( Diet , drugs , diagnostics , Transport , caesarian section
, Blood )
PMSMA (PRADHAN MANTRI SURAKSHIT
MATRITVA ABHIYAN )
Identify danger signs
Stickers :
Green
No risk factor
Red
High risk pregnancy
Blue
PIH
Yellow
Comorbidities like Diabetes ,
Hypothyroidism , PIDs
LAQSHYA
Promote Labour room quality
DAKSHATA
Train doctors and ANMs for intrapartum and immediate
postpartum care
SUMAN ( Surakshit matritva aashwasan)
Service guarantee charter +
Grievance redressal mechanism +
Zero tolerance policy
Flashcard 62 :Schemes for child health
HBNC (HOME BASED NEWBORN CARE ) :
Home visits by ASHA
Number of visits –
7 : Home delivery (Days 1,3,7,14,21,28,42 )
6: – Hospital delivery (Vaginal delivery)
5 : Hospital delivery –Cesearian
Incentive – 250 rs per child
HBYC(HOME BASED CARE OF YOUNG CHILD):
Home visits by ASHA
5 Visits (3,6,9,12,15th month)
Incentive – 250 rs per child
FBNC (FACILITY BASED NEWBORN CARE ) :
SNCUs : at District hosp/SDHs
NBSUs : at CHCs/FRUs
NCCs : in Labour rooms
INAP (INDIAN NEWBORN ACTION PLAN )
Single digit NMR and Still Birth Rate by 2030
RBSK (RASHTRIYA BAL SWASTHYA KARYAKRAM
)
Screen 4 Ds: (Defects,Deficiencies,Disease,
Developmental delay and disabilities)
MAA (MOTHERS ABSOLUTE AFFECTION )
Promote Exclusive breast feeding
SAANS ( Social awareness and action to neutralize Reduce deaths from pneumonia
pneumonia successfully)
Flashcard 63 : Malaria drug policy
Treatment
Falciparum :
ACT for 3 days + Primaquine 1 dose(Prevent recrudescence)
North east states: Artemether + Lumefantrine
Other states : Artesunate + Sulfadoxine-pyrimethamine
Vivax :
Chloroquine + Primaquine for 14 days ( Prevent relapse )
Mixed infection
ACT for 3 days + Primaquine for 14 days
Ovale :
same as vivax
P.Malariae :
Same as falciparum
Pregnancy
Falciparum :
( Primaquine is
contraindicated )
First trimester - Quinine
0ther trimesters - ACT
Vivax :
Chloroquine
Chemoprophylaxis :
Depends on duration
of stay
Upto 6 weeks :
Doxycycline
>6 weeks
Mefloquine
(If contraindicated : Use chloroquine)
Flashcard 64 : KALA AZAR elimination
Endemic states
Bihar , west Bengal , UP , Jharkhand
Elimination target
Incidence of less than 1 case per 10000 population
( at block level )
KA suspect
Fever,anemia,hepatosplenomegaly – Not responding to
antimalarials
Diagnosis
Rapid diagnostic kit : rK39
rk 39----- + ---- Start treatment
Treatment
DOC: Liposomal amphotericin B (Single dose infusion)
Oral Rx : Miltefosine (Directly observed treatment )
Active case finding :
KALA AZAR FORTNIGHT
Search for 2 weeks
Only in endemic areas
To be done once in 3 months (Quarterly search)
Indoor residual spray :
For sand fly
SYNTHETIC PYRETHEROIDS : preferred over DDT
Flashcard 65 : Filariasis elimination
Elimination strategy :
MAPPING -- MDA -- TRANSMISSION ASSESSMENT SURVEY
MAPPING
Measure antigenemia – Immunochromatography test
If Prevalence > 1% --- Endemic area – Start MDA
MASS DRUG ADMINISTRATION :
MDA
Triple drug therapy – IDA (Ivermectin + DEC + Albendazole)
Once a year : For 5 years
Coverage : 85% of eligible population
Contraindication : Pregnancy , child less than 2 years,Seriously ill
TRANSMISSION ASSESSMENT
SURVEY
If infection is below threshold level – Stop MDA
Flashcard 66: HIV - ART
ART
Test and treat policy :
Start treatment
irrespective of CD4
counts/staging
Monitoring
Age > 10 yr and
Weight > 30 kg :
Tenofovir
Lamivudine
Dolutegravir
TLD
Age 6-10 yr and
Weight 20-30 kg
Abacavir
Lamivudine
Dolutegravir
Age < 6 yr
Weight < 20 kg
Abacavir
Lamivudine
Lopinavir/ritonavir
Clinical monitoring :
Weight , TB screening ,
Treatment adherence , IRIS
Every month
Immunological monitoring:
Every 6 months once
CD4 count
(Can be stopped if CD4 count reaches 350
cells/cubic mm and plasma viral load is less than
1000 copies/ml )
Virological monitoring: Plasma
viral load
At 6 months , 12 months after ART and then every
12 months
Flashcard 67: HIV - PPTCT
✓Pregnant
Testing strategy
Opt out testing (Test offered routinely but client can decline if not
willing to )
Treatment
✓TLD is preferred over TLE
(Tenofovir + Lamivudine+ Dolutegravir)
✓Start treatment irrespective of gestation/CD4 counts/staging
✓Newborn
Prophylaxis
If Mother on ART : use Nevirapine (Minimum duration: 6 wks )
Not on ART – High risk infant : Nevirapine + Zidovudine
Diagnosis
Early infant diagnosis : at 6 weeks (Test - DNA PCR or NAT )
Confirmatory testing : at 18th month
Cotrimoxazole
prophylaxis
From 6 weeks (Till 18 months once HIV is ruled out )
Feeding
Breast feeding is not contraindicated
Avoid mixed feeding
Flashcard 68: HIV – PROPHYLAXIS
PEP for HIV Age > 10 yr and Weight > 30 kg
Tenofovir Lamivudine Dolutegravir
Age 6-10 yr and Weight 20k-30kg
Zidovudine Lamivudine Dolutegravir
Age < 6 yr or Weight < 20 kg
Zidovudine Lamivudine Lopinavir/ritonavir
PEP should be administered immediately (Maximum benefit if
started within 2 hours) and preferably within 72 hours
Duration : for 4 weeks (28 days)
Note : Best (as per WHO) : TED - Tenofovir + Emtricitabine +
Dolutegravir
To prevent PCP
Cotrimoxazole
Prevent
opportunistic To prevent TB
infections
To prevent recurrence of
cryptococcal infection
Isoniazid
Flucanazole
Flashcard 69: POLIO ELIMINATION
Polio free – India/SEAR:
March 2014
Polio free WHO regions
5 out of 6 WHO regions have eliminated Polio
Polio endemic region
East Mediterranean region
Polio endemic countries - 2 :
Pakistan , Afghanistan
Wild polio strains eradicated :
WPV 2 and WPV 3
Not eradicated
WPV 1
VDPVs (Vaccine derived polio virus)
3 Types: c VDPV , i VDPV , a VDPV
Most common - c VDPV i.e Circulating VDPV
Most commonly due to : mutation in type 2 component
Prevention : Switch : tOPV replaced by bOPV
VAPP: Vaccine associated paralytic polio
Paralysis in children with congenital immunodeficiency after OPV
Seen after 4-30 days of receiving OPV
Most commonly due to : Mutation in Sabin 3 component
Prevention :Shift : OPV (Live) to be replaced by IPV
Flashcard 70:AFP SURVEILLANCE
Stool sample collection and
transportation
2 samples collected 24 hours apart (Each sample – 8 grams)
Ideally : within 2 weeks
Maximum limit : within 2 months (60 days )
Transport : at 2-8 degree ( Reverse cold chain)
Outbreak response immunization
(ORI) : In that community
1 dose of OPV : for 0-59 months of age (Irrespective of previous
vaccination status )
Atleast 500 children to be vaccinated
60 day follow up
To confirm residual weakness (Mid-thigh circumference – To reveal wasting
) : To be done 60 days after onset of paralysis
Confirmatory report
All cases should be confirmed as polio (Yes/no) : Within 90 days
Indicators (Most important)
Non polio AFP rate
Identify > 2 cases per 1 lakh population
Indicate operational efficiency or sensitivity of
surveillance
Adequate sample
collection
2 samples collected ideally within 2 weeks
To be done in > 80% of cases
Flashcard 71: STI KITS
Kit 1: Grey
Urethral Discharge
Ano-rectal discharge
Cervical Discharge
Tab Azithromycin + Tab. Cefixime
Kit 2: Green
Vaginal Discharge
Tab. Secnidazole + Cap. Fluconazole
Kit 3: White
Genital Ulcer-Non herpetic
Inj. Benzathine penicillin + Tab Azithro
Kit 4: Blue
Genital Ulcer-Non herpetic
(Allergic to Penicillin)
Doxycycline + Tab Azithromycin
Kit 5: Red
Genital Ulcer- Herpetic
Tab. Acyclovir
Kit 6: Yellow
Lower Abdominal Pain
Tab. Cefixime + Tab. Metronidazole + Tab. Doxy
Kit 7: Black
Inguinal Bubo (IB)
Tab. Azithromycin + Tab. Doxycycline
Mnemonic : Go Green with Blue rivers
and Yellow buds
Flashcard 72: ICDS
Ministry
Ministry of women and child development
Heart of ICDS
Anganwadi centre (AWC )
Norms
Urban and rural area : 1 AWC for 400-800 population
Tribal area : 1 AWC for 300-800 population
( 1 mini AWC for 150-300 population)
Administrative unit
Community development block
Services
Supplimentary nutrition
Health check up
Immunization
Non formal pre school education
Health education
Referral services
Supplimentary nutrition
Growth charts in AWCs
Calories (Kcal)
Protein (Gms)
Child ( 6m – 6 yrs)
500
12-15
Pregnant and lactating mothers
600
18-20
Severely malnourished Child
( 6m – 6 yrs)
800
20-25
Based on Multigrowth reference study (MGRS)
PM-JAY (Pradhan Mantri Jan Arogya Yojana)
PMMVY (Pradhan Mantri Matru Vandana Yojana )
As a part of Ayushman Bharat Scheme : Under
MOHFW
Under Ministry of women and child development
Health coverage upto Rs. 5 lakhs per family per
year for secondary and tertiary care
Cash incentive of ₹ 5000/- to Pregnant of 19 years of age
or above for the first live birth
No restriction on the family size or age
Is implemented through the Anganwadi Centers (AWC).
It covers up to 3 days of pre-hospitalization and
15 days post-hospitalization expenses
1st instalment Rs 1000
On early registration at the
Anganwadi Centre (AWC) /
Health facility
Includes empanelled hospital (public or private)
anywhere in the country.
2nd instalment
After six months of
pregnancy on receiving at
least one ANC
Eligibility: deprived rural families and
occupational categories of urban workers’ as
per Socio-Economic Caste Census
Rs 2000
3rd instalment Rs 2000
After birth registration and
the child has received BCG,
OPV, DPT and Hep - B or its
equivalent/ substitute
Flashcard 74: NCD – GLOBAL ACTION PLAN
9 targets to be achieved by 2025 :
• At least 10% relative reduction in the harmful use of alcohol
• A 10% relative reduction in prevalence of insufficient physical activity
• A 25% relative reduction in the overall mortality from cardiovascular diseases, cancer,
diabetes, or chronic respiratory diseases : (25 by 25 – i.e To be achieved by 2025)
• A 25% relative reduction in the prevalence of raised blood pressure
• A 30% relative reduction in mean population intake of salt/sodium
• A 30% relative reduction in prevalence of current tobacco use in aged 15+ years
• At least 50% of eligible people receive drug therapy and counselling (including glycaemic
control) to prevent heart attacks and strokes
• An 80% availability of the affordable basic technologies and essential medicines
• Halt the rise in diabetes and obesity
Flashcard 75: Screening test vs Diagnostic test
Screening test
HIGH SENSITIVITY
For apparently healthy
Based on one criteria (cutoffs) (Test
results are arbitrary and final )
Not sufficient basis for treatment
Initiative from investigator
Applied to groups
Less accurate
Less expensive
Diagnostic test
HIGH SPECIFICITY
For persons with signs and symptoms
Based on signs, symptoms, and lab
findings
Sufficient basis for treatment
Initiative from a person with
complaint
Applied to individuals
More accurate
More expensive
Flashcard 76: Test parameters
Sensitivity
TP / TP + FN
Specificity
TN / TN + FP
ACCURACY
TP + TN / TP + TN + FN + FP
(Total correct results)
PPV
TP / TP + FP
(Hint – Include only positives)
NPV
TN / TN + FN
(Hint – Include only Negatives)
Flashcard 77: Screening : Important points
If 2 tests are done in sequence (Serial testing) : Net sensitivity decreases and net specificity increases
❑ If 2 tests are done together (Parallel testing) : Net sensitivity increases and net specificity decreases
❑ Post-test probability depends upon: depends on sensitivity, specificity, pretest probability (Prevalence)
❑ PPV is most affected by: Prevalence
❑ Formula of positive likelihood ratio : Sensitivity / 1- specificity
❑ Used to decide the Diagnostic cutoff point: ROC curve
❑ Time between first point of detection and final critical point : Screening time
❑ Time between point of detection and usual time of diagnosis : Lead time
❑ Screening is useful in diseases with: Long lead time
Flashcard 78: Screening : Types
Prospective screening
Prescriptive screening
To screen
Communicable disease
NCDs
To stop
Transmission of disease To stop progression of disease in a
patient
Main purpose Disease control
Disease detection
Example
PAP smear
Breast self examination
Neonatal screening
HIV screening in
prostitutes
Screen immigrants
Flashcard 79: Screening :Wilson Jungner criteria
Disease
Natural history of disease
Latent or early symptomatic stage
Suitable test
The test
Agreed policy
Accepted treatment
Facilities for diagnosis and treatment
Case finding should be
Case finding should be
should be an important health problem
should be well understood
Present
Available
should be acceptable
On whom to treat
Available
Available
Cost effective
Continuous process
Flashcard 80: DATA REPRESENTATION
Histogram
Frequency polygon
Frequency curve
Frequency distribution of quantitative continuous data
Ogive curve
To represent cumulative frequency
Bar chart
Frequency distribution of qualitative data
Line diagram
To show trend of an event
Scatter diagram
To depict correlation – Relationship between two quantitative
variables
Ex: Height and weight , Income and IMR
Box whisker plots
To represent 5 point statistics :
Min value – First quartile – Second quartile-Third quartile-Max value
Venn diagram
To represent overlapping probabilities
Spot maps
To show place distribution of disease
Pictogram
Pictoral representation of qualitative data
Flashcard 81: BIOSTATS : Important points
❑ Right or positive skewed data : Mean > Median > Mode
❑ Left or negative skewed data : Mean < Median < Mode
❑ Preferred measure of central tendency for skewed data : Median
❑ As sample size increases : Standard error decreases
❑ As sample size increases : Width of confidence interval decreases
❑ Sampling used for heterogenous population to ensure proper representation: Stratified random sampling
❑ Tracing contacts and sampling done in hidden population : Snow ball sampling
❑ Used to compare variation of 2 variables measured in two different units : coefficient of variation
❑ To express strength of relationship between 2 quantitative variables : Corelation coefficient
❑ To predict the variation in dependent variable wrt independent variable : Coefficient of regression
Flashcard 82: TESTS OF SIGNIFICANCE
To compare Mean values
To compare proportions
Between 2 groups
Student t test or
unpaired t test
For more than 2 groups
ANOVA test
Within 1 group
(Before-after intervention)
Paired t test
Between 2 or more than 2
groups
Chi square test
Within 1 group
(Before-after intervention)
Mcnemar test
To check significance of association
Chi square test of association
Parametric tests
Student t test , ANOVA test , paired t test
Non Parametric tests
Chi square test , Mcnemar test, Man-whitney test,
Kruskal wallis test, wilcoxon sign rank test
Flashcard 83: TYPES OF ERROR
Type 1 error
Type 2 error
• False positive error
• False negative error (Beta error)
• No difference in reality but analysis showing
significant results
• Not able to identify significant difference
• Rejecting a true null hypothesis
• Not rejecting a false null hypothesis
• Threshold limit of type 1 error : Alpha
• Can happen due to : less sample size
• Probability of type 1 error committed : P value
• Power : Ability to identify significant difference (1beta)
• If p value is less than alpha : Reject null hypothesis
• Power is increased by increase in sample size
• Most commonly used p value : <0.05
Flashcard 84: FERTILITY INDICATORS
•
Crude birth rate
✓ No. of live births per 1000 mid year population
•
General fertility rate
✓ No. of live births per 1000 women in reproductive ag
•
Total fertility rate
✓ Average number of children a woman through her reproductive years
✓ It is computed by summing the age-specific fertility rates for all ages
✓ Indicates magnitude of “completed family size”
✓ Crude birth rate = ( 8 x TFR ) + 1
•
Gross reproductive rate
✓ Average number of girls that would be born to a woman throughout her reproductive span
assuming no mortality
✓ GRR = TFR / 2
•
Net reproductive rate
✓ Number of daughters a newborn girl will bear during her lifetime assuming fixed agespecific fertility and mortality rates
✓ NRR = 1 : Replacement level of fertility
✓ Best indicator of fertility
•
Couple protection rate
✓ Indicates prevalence of contraceptive practice
✓ Should be 60% and more to achieve NRR=1
Flashcard 85: IUDs
Shelf life (years)
Side effect
NOVA T
CuT 380 A
CuT 200
5
10
4
Most common – Bleeding
Most common complication for removal – Pain
Timings of insertion: ✓ During menstruation or within 10 days of beginning of menstrual period
Best time
CuT 200 : 3
CuT 380A : 0.5 – 0.8
LNG IUD : 0.2
Ideal IUD candidate Having atleast one child
Pregnancy rate (%)
(As per PPFA )
No history of pelvic disease
Normal menstrual periods
Willing to check IUD tail
Monogamous relationship
Access to follow up +
Flashcard 86: MCH INDICATORS
Perinatal mortality rate
Numerator
Still births + Early neonatal deaths
Denominator
Live births + Still
births
Perinatal mortality rate (for
international comparision )
Still births + Early neonatal deaths
(weight > 1000 gm )
Live births
(weight > 1000 g )
Neonatal Mortality Rate
Post neonatal Mortality Rate
Deaths < 28 days
Deaths between 28 days to 1 yr
Infant mortality rate
Under 5 mortality rate
Deaths < 1 year
Deaths < 5 yr
Child survival index
= 1000 – U5MR
10
“Death while pregnant or within 42
days of pregnancy, irrespective of
the duration and site, from cause
aggravated by the pregnancy or its
management but not from
accidental or incidental causes.”
Maternal mortality ratio
Multiplier
1000
Live births
Livebirths
100000
Flashcard 87: HIGH RISK APPROACH
High risk pregnant
At risk infant
Elderly primi ≥ 30 years
Birth wt : < 2.5 kg
Short statured Primi (140 cm and below)
Twins
Infertility treatment
Birth order 5 or more
3 or more spontaneous abortions
Artificial feeding
Post term pregnancy
APH
Eclampsia
Anaemia
Twin/ Breech
Previous LSCS
Systemic disease
Prolonged pregnancy
Elderly Grand Multi para
Weight: ≤70% of expected weight
Failure to gain wt. during 3 successive months
Children with PEM/diarrhoea
Working mother/one parent
Flashcard 88: Vitamin deficiencies
B1 (Thiamine)
Beri Beri
Wernickes encephalopathy
B2 (Riboflavin)
B3 (Niacin)
Angular stomatitis
⚫ Pellagra : Diarrhea , dermatitis , dementia
⚫ Glossitis + : Loss of papillae
⚫ Casals necklace + : Excoriations
⚫ Cereals responsible : Maize , jowar (Sorghum vulgare)
✓ Maize – lack of tryptophan
✓ Jowar – rich in leucine
B5 (Pantothenic acid)
B6 (Pyridoxine)
B9 (Folic acid)
Burning feet syndrome
Peripheral neuritis
⚫ Megaloblastic anemia, Glossitis
⚫ Severe deficiency : Infertility / sterility
B12 (Cyano cobalamine)
Vit E
Vit K
Pernicious anemia , neuropathy
Hemolytic anemia of newborn
Hemorrhagic disease of newborn
Prevention : Vitamin K1 at birth
Flashcard 89:ANEMIA MUKHT BHARAT
Age
Frequency
Dose
Children (6m-59 months )
Biweekly
1 ml IFA syrup
(1 ml contains 20 mg elemental iron and 100 μg FA)
Children (5-9 yrs)
Weekly
Pink tablet : 45 mg iron and 400 μg FA
Adolescents (10-19yrs)
Weekly
Blue tablet: 60 mg iron + 500 μg FA
Pregnant and lactating women
Daily
Red tablet: 60 mg iron + 500 μg FA
( 6 months from second trimester and for 6
months postpartum )
Reproductive women (20-49 yrs)
Weekly
Red tablet : 60 mg iron + 500 μg FA
Flashcard 90: Food adulterants and toxins
Disease
Lathyrism :
Spastic paralysis
Toxin
BOAA*
Adulterant
Khesari dal
(Lathyrus sativus)
Prevention
-Vitamic C prophylaxis
-Remove toxin :
Steeping,parboiling
Epidemic dropsy :
Pedal edema, cardiac
failure,Glaucoma
Sanguinarine
Argemone oil added to
mustard oil
Tests for detection :
Endemic ascites :
Jaundice, ascitis
Pyrrolizidine
alkaloids
(Hepatotoxic)
Crotalaria seeds
( Jhunjhunia)
Deweeding
Aflatoxicosis
Aflatoxin
(Hepatotoxic)
Clavine
Aspergillus flavus/
parasiticus
Claviceps purpura : On
bajra seeds
Avoid moisture
Ergotism :
Acute – nausea, vomit
Chronic – Vasoconstriction
Nitric acid test : MC done
Paper chromatography test :
Most sensitive
Float in salt water (20%)
before consumption
Flashcard 91: Nutrition
RDA:
Calcium (mg)
Iron (mg)
Iodine
(microgram)
Folic acid
(microgram)
Vit A
Man
1000
19
150
Woman
1000
29
150
Pregnant
1000
40
250
Lactation
1200
23
280
300
220
570
330
1000
840
900
950
ENERGY Requirement :
Activity
Sedentary
Moderate
Heavy
Males
Kcal
2110
2710
3470
Females
Kcal
1660
2130
2720
Extra requirement
Pregnancy : +350*
Lactation (0-6mths) : +600
Lactation (6-12mths) : +520
Flashcard 92: ENTOMOLOGY
Mosquito
Anopheles
Malaria
Culex
JE , West nile fever, Bancroftian filariasis, Viral arthritis
Aedes
Mansonoides
Yellow fever, Dengue ,Chikungunya , Rift valley fever
Brugian filariasis . Chikungunya
Sandfly
Kalazar , Oriental sore , Oraya fever , Sandfly fever
Tse-tse fly
African sleeping sickness
Louse
Epidemic typhus, relapsing fever, Trench fever, pediculosis ,vagabond disease.
Ratflea
Bubonic plague, Endemic typhus, hymenolepis diminuta
Black fly
Oncocerciasis
Reduvid bug
Chaga’s disease
Hard tick
Tick typhus , viral hemorrhagic fever,KFD (Within India) , Tularemia ,Tick paralysis ,
human babesiosis , Lyme’s disease.
Soft tick
Q fever (transmission between cattle ), Relapsing fever , KFD (outside India )
Trombiculid Mite
Scrub typhus
Cyclops
Guinea worm disease , Fish tape warm
Flashcard 93: PNEUMOCONIOSES
⚫ Silicosis-
•
Most common
•
Seen initially in Mica miners
•
Risk factor for tuberculosis
⚫ Asbestosis-
• Prevention : Dust control
Most dangerous
⚫ Anthracosis⚫ Byssinosis:
Asbestos is used in – Cement , glass , fireproof textiles
Coal miners
Seen in : Textile mills
⚫ Bagassosis:
-Cotton spinners are affected more
• Sugar cane waste
•
Seen in : Cardboard / paper industry
•
Agent : Thermoactinomycetes
•
Not notifiable under factory act
•
Prevention : 2% propionic acid
Moisture content of waste - > 20%
Flashcard 94: ESI BENEFITS
Type of benefits
Sickness
70% of daily wage is payable for 91 days
Extended sickness
(In order to qualify for sickness benefit the worker is required to
contribute for 78 days in a contribution period of 6 months.)
80% of daily wage payable for 2 years (730 days) for 34 diseases
Enhanced sickness
Maternity
Full wage upto 7 days for vasectomy and 14 days for tubectomy
Full daily wages
•
up to 26 weeks for confinement
•
up to 6 weeks for miscarriage or MTP
up to 4 weeks for sickness arising out of pregnancy,
confinement, premature birth
90% of daily wage till recovery
90% of daily wage
Pension at 90% of wages
15000/•
Temporary disablement
Permanent disablement
Dependant
Funeral expenses
Flashcard 95: HEALTH EDUCATION AND COMMUNICATION
PANEL DISCUSSION
Experts discuss a topic with no specific order of speeches
Audience can take take part
SYMPOSIUM
Series of speeches with no discussion among experts
Audience can take part
FOCUSSED GROUP
DISCUSSION (FGD)
Discussion among community members in a group of 6-12
Sociogram: Graphical representation of interaction
DEMONSTRATION
To show how to do activities for community
Ex: Use ORS , Wash dog wound
GATHER APPROACH :
G :Greet
A : Ask/ascertain – needs/problems
T : Telling different methods/options to solve problem
H : Help to make voluntary decision
E : Explain fully the chosen decision/action
R : Return for follow up visit
To counsel a client
Ex- In family planning
SPIKES PROTOCOL :
To disclose bad news
Set up the interview
Assess the patient's perception
Obtain the patient's invitation
Give knowledge and information to the patient
Address the patient's emotions with empathy
Strategy and summary
Flashcard 96: MANAGEMENT METHODS
Input
Output
Cost benefit analysis
Cost
Monetary terms
Cost effectiveness analysis
Cost
Results Ex: Lives saved
Cost utility analysis
Cost
QALYs gained (widely used)
Network Analysis
A graphic plan of all activities to reach ana objective
Ex: PERT (Programme Evaluation & Review technique)
CPM (Critical path method)
Work Sampling
Observation of activities at predetermined /random intervals.
Ex: Medical officer observing immunization session at random
intervals
System Analysis
Finding cost effectiveness of available alternatives.
Delphi Method
For decision making by experts
ABC Analysis
Method of inventory control (Stock management )
Based on cost factor
Flashcard 97: HEALTH COMMITTEES
Bhore committee
•
•
Social physicians (3 months of training in PSM )
3 million plan : Development of PHCs
Mudaliar committee
•
All India Health Services (like IAS)
Chadah Committee
•
1 health worker (for malaria & Family Planning)
Mukherji Committee
•
Delink malaria workers from family planning
Jungalwalla Committee
•
•
Equal pay for equal work and Special pay for specialized work
No private practice
Kartar Singh Committee
•
For Multipurpose workers
Shrivastava : Medical Education •
& Support Manpower
•
•
•
ROME (Reorientation of Medical Education)
Village Health guide
3 tier rural health infrastructure
Development of referral service complex
Krishnan Committee
Urban revamping scheme
Bajaj Committee
•
National Health Manpower Policy
HLEG (High level expert
committee)
•
•
UHC (Universal Health Coverage)
3.5 years B Sc community health
Flashcard 98: HEALTH CARE DELIVERY
SUBCENTRE
PHC
CHC
Level of care
Primary
Primary
Secondary
First contact point between
community and :
Health
Doctor
Specialist
Population
norm
Plains
5000
30000
1,20,000
Hilly/Tribal areas
3000
20000
80,000
Inpatient beds
Nil
4-6
30
Staff
Health workers :
Male/ female (ANM)
Medical officer +
Health assistants +
Specialists +
Referral unit for
Nil
For 6 subcentres
For 4 PHCs
First referral unit – To
conduct emergency CS
Classification (A and B – Based
on number of deliveries per
month)
SC – A
No deliveries
PHC-A
< 20
SC- B
< 10
PHC-B
> 20
Maintenance
Central Govt
State govt
Not classified as such
State govt
Flashcard 99: BMW
Red Bag
i.v. Tubes, catheters, Urine bags, Syringes without needles, Hazmet suit,
Vaccutainers,Goggles, face-shield, splash proof apron, nitrile gloves
Yellow bag
❑ Anatomical waste : Human and animal
❑ Soiled : contaminated with blood and body fluids (Linen, swabs )
❑ Cytotoxic drugs, Expired/ discarded medicines
❑ Chemical liquid : Silver X ray film
❑ Blood bags, culture
❑ Used mask ,head cover, shoe-cover, disposable linen (non-plastic)
White: puncture
proof container
Needles, syringes with fixed needles, blades, scalpels
Blue: cardboard
box
Glass: Broken glass - medicine vials and ampoules (Except contaminated with
cytotoxic waste)
Metals: Nails, metallic implants
Flashcard 100: DISASTER MANAGEMENT
NDMA - CHAIRMAN
Prime minister
NIDM- President
Home minister
Disaster management
cycle
Impact--Response--Rehabilitation–-Reconstruction–-Mitigation–Preparedness
Most common infection
Gastro enteritis
Most common deficiency
Vitamin A
Mass vaccination
Not necessary for
Cholera , Typhoid , Tetanus
Necessary
Measles , varicella , Rotavirus
Mitigation – reduce risk factors to avoid further damage
Diseases reported
Gastro enteritis
ARI
Zoonoses – Leptospirosis, Rat bite fever , Rickettsiosis , Rabies , Equine
encephalitis , plague
Vector borne disease – malaria , dengue ,
Triage :
Red
Highest priority
Yellow
Medium priority
Green
Ambulatory
Black
Dead/Moribund – Least priority
Based on likelihood of
survival
THANX FOR ALL YOUR FEEDBACKS AND REVIEWS
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103
105
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It was so good to be with u on our
insta journey for the past 3 months ..
Thanx for being a part of our journey ..
Best wishes
Yours – RAJEEV SHETTY
Dr. Rajeev Shetty
MD PSM (MAMC, NewDelhi)
MIPHA ,MIAPSM
Faculty DAMS: 2013-2022
Faculty DBMCI: From 2023
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